Pediatric Unconscious

EMT11KDL

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You respond to a 2 Yo, 12kg, Unconscious but slightly responds to painful stimuli. According to the Mother the child has been sick for the past 4 days, with Nausea Vomiting and Diarrhea. Also the child has not been eating or drinking fluid for the past 36 hours. Mom also tells you that the child has not vomited for the past 4 hours. Child went unresponsive about 30 mins prior to arrival. Mom states the child takes no Medication, was given Tylenol yesterday, No medical/surgical history. No Allergies. Up to date on vaccinations.

VS- 170's HR, 64/33, 40 Resp Shallow and clear lung fields, 89% on a finger probe (Adult Probe, Pediatric unavailable because you forgot to check the pediatric bag). Temp 104.3 F Rectal

Treatment plan?
 

NomadicMedic

Pot or Kettle? Unsure.
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Sepsis. Fluid resuscitation while heading to the ED. Depending on presentation during transport; maybe RSI, maybe pressors.
 

Ewok Jerky

PA-C
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Agreed: sepsis + dehydration +/- aki and likely electrolyte imbalance.

Fluids and a speedy ride to pediatric hospital please.
 

NTXFF

Forum Crew Member
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I too am going with sepsis. IV access two if possible and get the fluids goin. I'm leaning hard towards RSI with the information presented. You've got a 2 year old that's breathing 40 times a minute and their sats are at 89%.... How much longer can this kid keep that up? I'd rather intubate and protect that airway then try and get it bouncing down the road to the hospital. Another consideration and something I've seen is with a temp like that when you begin introducing fluid of any kind a seizure becomes a big concern, again pushes me more towards RSI.
 

phideux

Forum Captain
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I agree with the IV and the fluids, distance to the hospital will decide whether I BLS or ALS the airway. But at a minimum, They're getting a mask and some O2 while I'm working on the lines and fluid.
 
OP
OP
EMT11KDL

EMT11KDL

Forum Asst. Chief
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What is causing the patient to breath at 40 times a minute and shallow? Its most likely the temp and dehydration. I do not believe that this patient would benefit on RSI Right away because Resp is not the issue. Cooling the the child and giving fluid will most likely see changes in mental status and improvement in Vitals.

As someone said that giving cold fluid will possibly cause seizures, this is correct but this primarily happens when you slam COLD fluid, like the fluid we would use for hypothermia treatments. Also if you are giving 240 ml bolus at a time of just room temp fluid the chances of you seeing that are slim.
 

Gurby

Forum Asst. Chief
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This guy probably ends up getting an IO from me, unless my partner is an IV god or the kid has good veins. Fluid bolus and see what happens. I'd like to check a sugar too.
 

TransportJockey

Forum Chief
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Agreed with the above posts and add in POC lactate as well.
 
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